Change in individual physicians’ screening mammography completion rates following the updated USPSTF guideline supporting shared decision making: An observational cohort study

• Published in: Patient education and counseling Vol. 105; no. 1; pp. 166 - 172
• Main Authors: Martinez, Kathryn A., Deshpande, Abhishek, Lipold, Laura, Rothberg, Michael B.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-01-2022
• Subjects: Adult; Breast Neoplasms - diagnosis; Cohort Studies; Decision Making; Decision Making, Shared; Early Detection of Cancer; Female; Guidelines; Humans; Mammography; Mass Screening; Middle Aged; Physicians; Shared decision making; Shared decision making; Mammography; Guidelines
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2021.05.011

•The strongest predictor of a physician’s post-2009 screening behavior was their pre-2009 screening behavior.•Physicians may not be practicing shared decision making in accordance with the USPSTF recommendation to do so.•Physicians new to the health system after 2009 have lower screening rates.•Physicians who practiced prior to the guideline change may need additional support in practicing shared decision making.
To understand changes in physician screening practices in response to the 2009 U.S. Preventive Services Task Force recommendation supporting shared decision making (SDM) for mammography in women aged 40–49 years.
We assessed screening completion rates for physicians in the Cleveland Clinic Health System pre-2009 (2006–2008) and post-2009 (2010–2015), and rates for physicians new to the system post-2009. We used mixed effects logistic regression to estimate the odds of a woman receiving screening post-2009. If physicians practiced SDM, we hypothesized their screening rates would change after 2009. To test this, we included each physician’s pre-2009 screening rate as a predictor in the model.
Among 125 physicians, the screening rate increased from 40% to 45% from pre-2009 to post-2009. For physicians new to the health system post-2009 the rate was 32%. In the mixed effects model (N = 17,007), the strongest predictor of mammography receipt among patients post-2009 was their physician’s pre-2009 screening rate (aOR:3.57 per 10% increase in pre-2009 rate; 95%CI:1.69–7.50).
Whether a woman received a mammogram post-2009 was highly associated with her physicians’ pre-2009 screening rate, suggesting physicians are not individualizing screening decisions via SDM.
Physicians may need support to effectively practice SDM.